Antibiotic therapy in sepsis: No next time for a second chance!

Abstract

What is known and objective: Sepsis is a life-threatening organ dysfunction associated with a high rate of morbidity and mortality. Appropriate antibiotic therapy remains the cornerstone of sepsis and septic shock management.

Comment: Although the early initiation of antimicrobial agents in the treatment of sepsis is widely acknowledged, the selection and adjustment to optimal dosage can be equally important. Since significant pathophysiological changes in the critically ill patients lead to altered pharmacokinetics of antibiotics, early consideration of pharmacokinetic/pharmacodynamic (PK/PD) properties is necessary for optimal antibiotic dosing in sepsis and should be integrated in practice.

What is new and conclusion: Where possible, an individualized antibiotic dosing approach through the application of therapeutic drug monitoring (TDM) service should replace the conventional dosing in critically ill patients with sepsis. Finally, antimicrobial stewardship can help improve clinical outcomes.

Keywords: Acute Kidney Injury (AKI); Antibiotic Dosing; Antimicrobial Agents; Augmented Renal Clearance (ARC); Critical Illness; Dose Adjustment; Pharmacodynamics; Pharmacokinetics; Sepsis; Therapeutic Drug Monitoring (TDM).